POS0301 IMPACT OF NSAIDS ON 8-YEAR INCIDENCE OF MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH ANKYLOSING SPONDYLITIS
Authors: O. Fakih, M. Desmarets, B. Martin, C. Prati, D. Wendling, E. Monnet, F. Verhoeven
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease associated with the occurrence of major cardiovascular events (MACEs). The effect of AS treatments on the occurrence of MACEs is poorly studied, especially for non-steroidal anti-inflammatory drugs (NSAIDs), whose cardiovascular risk remains debated in this disease. <h3>Objectives</h3> To determine the incidence of MACEs in patients newly benefiting from long-term illness (LTI) for AS and to study the relationship between AS treatments and MACEs. <h3>Methods</h3> This national cohort study was based on the national health data system Système National des Données de Santé (SNDS), a French national medico-administrative database containing data containing administrative data, data on LTIs, outpatient care and medication consumption, and hospitalizations of all beneficiaries of the French health insurance system. All patients newly benefiting from the LTI #27 "severe spondyloarthritis", with associated diagnostic code M45 (AS), between 2010 and 2013, were included. The use of LTI allowed us to build a cohort of patients with a supposedly active disease, the SNDS, being a medico-administrative database, having no data on the activity of the disease. All patients with active SpA despite NSAID treatment, and therefore requiring disease-modifying anti-rheumatic drugs (DMARDs), were theoretically newly enrolled in the LTI scheme. The end date of follow-up was 31 December 2018. The occurrence of MACEs (stroke and myocardial infarction [MI]) and comorbidities (diabetes, hypertension, dyslipidemia, smoking, obesity, chronic kidney disease, atherosclerosis, and depression) were identified using algorithms previously described in the literature. An analysis taking into account the competitive risk of death and an inverse propensity score weighting (determining the likelihood of NSAID treatment) was performed to compute cumulative incidence functions and determine the subhazard ratios (SHRs) for the occurrence of MACEs for the different treatments of interest. <h3>Results</h3> Between 2010 and 2013, 22929 patients were included (mean age 43.0 (SD 13.9) years, 44.9% male). During follow-up, 344 MACEs (195 strokes, 152 MI) and 415 deaths were identified. The cumulative 8-year incidences of MACE, stroke and MI were 1.81% [1.61-2.05], 0.97% [0.83-1.14] and 0.85% [0.71-1.04] respectively. The occurrence of MACE was associated in univariate analysis with age (SHR: 1.07 [1.06-1.07]), male sex (SHR: 1.61 [1.31-2.00]), diabetes (SHR: 2.21 [1.63-3.00]), dyslipidaemia (SHR: 3.67 [2.96-4.57]), and hypertension (SHR: 3.74 [2.87-7.49]) (p&lt;0.001 in all cases). After inverse propensity score weighting, NSAIDs (SHR: 0.40 [0.32-0.49], p&lt;0.001) and anti-TNFs (SHR: 0.61 [0.47-0.81], p&lt;0.001) were associated with a lower risk of MACE occurrence, which was not the case for conventional synthetic DMARDs (SHR: 0.89 [0.63-1.24]) and anti-IL17 (SHR: 2.06 [0.78-5.44]). Similar results for DMARDs were found when stratifying the analysis on the presence or absence of NSAID treatment (Table 1). <h3>Conclusion</h3> The incidence of MACEs at eight years is low in patients newly benefiting from LTI for AS. Our results support the hypothesis of a protective role of NSAIDs and anti-TNF drugs on cardiovascular risk in these patients. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None declared.